Provider Demographics
NPI:1164508966
Name:JOSEPHSON, NEIL C (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:C
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1239
Mailing Address - Country:US
Mailing Address - Phone:206-292-6570
Mailing Address - Fax:
Practice Address - Street 1:921 TERRY AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1239
Practice Address - Country:US
Practice Address - Phone:206-292-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031755207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID3221000Medicaid
WA158866284OtherGROUP NPI
WA8218570Medicaid
WA8218570Medicaid
WAG000162200Medicare PIN